Question on Atopic Dermatitis

Dear Dr. Spence,
I would appreciate any information you could give with regards to atopic dermatitis and any possible support groups that may be available.
Signed,
Ima Scratchin

Dear Ima Scratchin,
Atopic dermatitis, or eczema, is a chronic, itchy skin condition affecting roughly 15-20% of children and 1 to 2% of adults. Onset is usually before two years of age, though it can manifest itself at any age. It is worse between the ages of two and four, but generally improves over time and is often characterized by inflamed, red, blistered or weepy patches during a flare. In between, skin may be normal or have chronic eczema with dry, thickened itchy areas. Atopic dermatitis seems to occur more frequently in people who have an "atopic tendency" – in other words, the condition is linked to diseases like asthma and allergic rhinitis. These conditions tend to be familial with a parent or sibling being affected as well. There is consensus that there is no known single cause of atopic dermatitis. There may be an immunologic link, though theories suggest possible contributors such as skin cell defects, gene mutations or even bacterial contamination. Of course, treatment primarily focuses on avoidance of any potential trigger, environmental or otherwise. Dry skin is an exacerbating factor, therefore use of regular emollients (lotions, cream, petroleum jelly) is recommended. Winter weather, frequent bathing, soaps and chlorinated pools all may increase skin dryness and effect outcomes. Environmental allergies (i.e. grass, dust, cat dander), stress and food allergies may also play a role in the disease (one-third of patients will have a food allergy). There is no cure for atopic dermatitis, but aggressive management may alleviate and control symptoms. As mentioned, emollients to prevent dry skin are the mainstay of therapy. Topical steroids are next in the arsenal. They are extremely effective but their use is limited in areas with thin skin (face, groin) due to the potential for skin atrophy. Newer agents like protopic and elidel, so-called calcineurin inhibitors, may treat mild to moderate disease and are generally used to prevent flares while steroids are better for the flare itself. There are innumerable websites with information on this subject. I particularly like www.dermnetnz.org/dermatitis/atopic - the Kiwis do a nice job! The National Eczema Association has a quarterly newsletter available called the Advocate (www.nationaleczema.org). A free book for children entitled "Under My Skin" can be obtained through the National Eczema Association for Science and Education (NEASE) at 415-499-3474. This organization also has information regarding support groups within the state and even has an application so you may start your own. Good luck!

Do you have any medical questions or concerns that you would like addressed? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.